Ng W L, Stevenson C E, Wong E, Tanamas S, Boelsen-Robinson T, Shaw J E, Naughton M T, Dixon J, Peeters A
Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Obes Rev. 2017 Apr;18(4):460-475. doi: 10.1111/obr.12498. Epub 2017 Jan 24.
Obesity is associated with excessive daytime sleepiness, but its causality remains unclear. We aimed to assess the extent to which intentional weight loss affects daytime sleepiness. Electronic databases were searched through 24 October 2016. Studies involving overweight or obese adults, a weight loss intervention and repeated valid measures of daytime sleepiness were included in the review. Two independent reviewers extracted data on study characteristics, main outcome (change in daytime sleepiness score standardized by standard deviation of baseline sleepiness scores), potential mediators (e.g. amount of weight loss and change in apnoea-hypopnoea index) and other co-factors (e.g. baseline demographics). Forty-two studies were included in the review. Fifteen before-and-after studies on surgical weight loss interventions showed large improvements in daytime sleepiness, with a standardized effect size of -0.97 (95% confidence interval [CI] -1.21 to -0.72). Twenty-seven studies on non-surgical weight loss interventions showed small-to-moderate improvement in daytime sleepiness, with a standardized effect size of -0.40 (95%CI -0.52 to -0.27), with no difference between controlled and before-and-after studies. We found a nonlinear association between amount of weight loss and change in daytime sleepiness. This review suggests that weight loss interventions improve daytime sleepiness, with a clear dose-response relationship. This supports the previously hypothesized causal effect of obesity on daytime sleepiness. It is important to assess and manage daytime sleepiness in obese patients.
肥胖与日间过度嗜睡有关，但其因果关系仍不明确。我们旨在评估刻意减肥对日间嗜睡的影响程度。检索电子数据库至2016年10月24日。纳入综述的研究包括超重或肥胖成年人、减肥干预措施以及对日间嗜睡的重复有效测量。两名独立评审员提取了关于研究特征、主要结局（通过基线嗜睡评分标准差标准化的日间嗜睡评分变化）、潜在中介因素（如体重减轻量和呼吸暂停低通气指数变化）以及其他共同因素（如基线人口统计学特征）的数据。综述纳入了42项研究。15项关于手术减肥干预措施的前后对照研究显示，日间嗜睡有显著改善，标准化效应量为-0.97（95%置信区间[CI]-1.21至-0.72）。27项关于非手术减肥干预措施的研究显示，日间嗜睡有小到中度改善，标准化效应量为-0.40（95%CI-0.52至-0.27），对照研究和前后对照研究之间无差异。我们发现体重减轻量与日间嗜睡变化之间存在非线性关联。该综述表明，减肥干预措施可改善日间嗜睡，且存在明确的剂量反应关系。这支持了先前假设的肥胖对日间嗜睡的因果效应。评估和管理肥胖患者的日间嗜睡很重要。
